Children in England and especially girls are being under-treated, not over-medicated, for ADHD, new figures obtained by the Guardian suggest.
In June, Ofsted’s chief inspector of schools, Amanda Spielman, claimed too many children were being given Ritalin, the main drug for attention deficit hyperactivity disorder. She said reliance on drugs meant behavioural problems were not being addressed.
But new figures released to the Guardian by the NHS Business Services Authority (NHSBSA) under the Freedom of Information Act show that just 61,000 boys aged between 6 and 17 were prescribed ADHD drugs last year – about 1.5% of the population of boys in that age group, and far below global estimates that indicate 5.3% of children have the disorder.
The proportion of girls in receipt of an ADHD prescription is even lower: just 0.35% of the population of girls aged between 6 and 17.
Almost 75,000 children aged between six and 17 received a prescription for ADHD drugs in England in 2017/18. Fewer than one in five (18%) of these prescriptions were for girls.
Although studies in children typically show a male preponderance – most commonly about 3 to 1 – it is thought that ADHD is under-recognised in females. In adulthood, the male-female ratio for ADHD “appears to be approximately equal”, according to the Nice guidance, “again raising the possibility that the high gender ratios in childhood may be partly a result of under-identifying the problem in girls, or of a different presentation of symptoms in girls”.
This is reflected in the NHSBSA figures: while more males than females are being prescribed ADHD medication in younger age groups, the gap is significantly reduced in older age categories.
Spielman’s assertion that too many children were being diagnosed and given drugs for the condition was challenged by the all-party parliamentary group on ADHD. Jo Platt, Labour MP for Leigh who chairs the group, and the Scottish MP Daniel Johnson, who is on medication for ADHD, wrote to Spielman saying they were “very disappointed” with her comments.
Spielman replied that, while she recognised ADHD as a medical condition and would not discourage parents from seeking medical help, “there has been a significant rise in the number of children who are on medication for behavioural problems”.
In an August statement copied to the Guardian, she said: “A number of medical studies have raised the possibility of over-diagnosis. I am concerned that we may sometimes be dealing with the symptoms of bad behaviour without addressing the underlying issues.”
The NHSBSA data does not include information on the reason a drug is prescribed, meaning some of the products may have been prescribed for a condition other than ADHD. Since April 2015 the NHSBSA has recorded the number of individuals receiving prescriptions by counting the NHS numbers captured on prescription forms.
Each patient is counted just once regardless of how many different ADHD drugs were prescribed in the cited time period. To avoid double counting across age categories, the patient’s maximum age at the time of prescribing was used in the analysis.
The figures provided to the Guardian cover prescriptions dispensed through NHS Prescription Services in England, which come under the British National Formulary section for CNS stimulants and drugs used for ADHD. They exclude those prescribed and dispensed in prisons, hospitals and private prescriptions.
Platt said the new figures “present an extremely concerning picture of how we diagnose, support and treat those with ADHD in this country. Whilst we have suspected that girls were vastly undiagnosed, to find out that less than 20% of treatments were for girls is deeply alarming.
“ADHD affects girls just as it affects boys but due to the stigma and common misconception that ADHD is just naughty kids playing up, instead of the neurodevelopmental condition that it is, we know that girls can often slip through the net, struggling in school and in their personal lives without the support they need.
“That is why we urgently need intervention to firstly increase the support services offered to both children and adults, but also tackle the stigma around ADHD.
UK children with ADHD wait up to two years for diagnosis, say experts
“These figures also reinforce the need for the Department for Health and Social Care to begin collecting the number of diagnoses of ADHD. Whilst prescription figures are useful to see the stark gender gap in the treatment of ADHD, the collection of diagnosis statistics will give us a greater understanding of the scale and impact of the condition but also, crucially, highlight areas of best practice and the effectiveness of different treatment methods.”
Tony Lloyd, chief executive of the ADHD Foundation, said: “We have known for a long time that ADHD is under-diagnosed and under-medicated in the UK.”
ADHD is a recognised mental health condition characterised by hyperactivity, impulsivity and inattention. Lloyd said schools had in the past referred children and particularly boys to doctors because they were challenging in the classroom.
“Invariably it was driven by hyperactivity,” he said. “Boys tend to get noticed more.” A decade ago, about four boys were diagnosed for every one girl. Now, with better understanding of how girls are affected, that ratio has come down to about 2.8 boys to every girl.
But the numbers of children being prescribed medication that NHS guidance says can help them cope is still low. “I can only put this down to a combination of stigma and under-resourced children’s mental health,” said Lloyd. “Waiting lists are still one to two years in most places for children to get any assessment.”